There's money in the business of body parts

The caller, a body broker, says doctors are traveling to a hotel where they will practice surgical techniques with new instruments. The course's sponsors need bodies.

This is not an unusual event. Seminars such as this take place throughout the country to give doctors needed experience with new instruments or surgical techniques. (Graphic:How the body can be used after death)

And this is not an unusual call. Wade, director of the Maryland Anatomy Board, has a lot of bodies: state residents who donated their bodies, now carefully tucked away, unembalmed, in coolers. Body brokers call him several times a week.

These brokers are people who profit by providing bodies and body parts for medical research, and they come in many different forms. They might be representatives of tissue banks or companies that act as intermediaries between those who have bodies, such as medical centers, and those who need them, such as sponsors of surgical seminars.

Federal law prohibits the sale of human organs and tissue for transplantation. The law is widely considered a total ban on the sale of all body parts, although it does not specifically address the conveyance of parts for medical education and research.

In any event, those who act as go-betweens, including organ recovery agencies, may charge for their work. Some are conscientious professionals who help provide research cadavers. But others are van-driving entrepreneurs who walk a thin line between legitimacy and lawlessness.

A recent scandal at the University of California-Los Angeles, in which two men, including the director of UCLA's Willed Body Program, were arrested on charges of selling stolen body parts for their own profit, has turned a national spotlight on an industry that operates in the dark: the largely unregulated acquisition and dissemination of body parts for medical and scientific research.

News reports of shady characters trading bodies that were donated with the best of intentions have legitimate members of the research and transplant communities calling for more oversight. Their greatest fear is that people will stop donating the bodies that are so necessary for lifesaving transplants and research.

"The people who put their trust in us begin to have second thoughts and may not make a donation or may even withdraw their donation from a donor roll," Wade says. "The fallout is long-term."

Wade oversees the donations of 1,300 to 1,500 bodies a year. And there are 70,000 people alive today who have signed up to donate their bodies to Maryland's medical schools when they die.

When the broker calls to find bodies for the seminar, Wade stands between the surgical course's promise of "hands-on training" and a sweet profit for the corporate sponsor, which will charge thousands of dollars for such a seminar. Money pours in from several fronts: Doctors are willing to pay to learn new techniques on cadavers. And the makers of medical instruments are willing to pay more because the sales of those new tools will increase after the doctors learn how to use them.

Wade has seen this trade bloom over 30 years of working with the dead, and he thinks of what's best for the deceased and their families when he gets these calls. He is the worst nightmare for a body broker looking for shortcuts and fast money.

Before Wade will release a body, there are layers of paperwork and phone calls to verify key details. He wants to know exactly where the body is going, how it will be transported and what it will be used for. He tracks every body and every body part. Every part is either returned to him or is cremated under his direction. The remains then are returned for a ceremony to which the families are invited.

Hearing all of this, the body broker on the other line hangs up, saying, "I don't need this lecture."

The benefits

Medicine depends on the dead.

Organ transplants save about 20,000 lives a year through dramatic surgical swaps that often include using helicopters and jets to move organs quickly.

Tissue transplants help about 1 million people a year; the blind get eyes as good as new, burn victims get bandages made of human skin.

Bodies used for research drive medical advancements by helping inventors to create safer surgical tools and medical professionals to hone their skills. The availability of cadavers allows crucial skills to be sharpened before a life depends on fast and flawless execution.

Because all of these medical benefits rely on the same selfless gift, leaders in each area cringe when the public's trust is threatened by misdeeds.

Helen Leslie, president of the Association of Organ Procurement Organizations, whose 59 members ask grieving families for permission to transplant organs into those on waiting lists, says the entire system relies on public trust. "What hurts is the buzz," she says. "The impression that there is a lack of integrity is devastating."

Alexander Capron, director of ethics, trade, human rights and health law for the World Health Organization, says the way in which bodies are treated after death either builds or diminishes trust by the public. And if the public loses trust in the system, thousands of lives are at stake.

"Any time you have an apparent abuse of the system, you potentially shake public confidence," he says. "This could undermine organ donations."

What government and medical professionals in the USA do, or don't do, to impose order on this vital but sometimes seamy outpost of modern medicine will be watched around the world, Capron says.

"What the U.S. does leads the rest of the world," he says. "People say if they can do it in the U.S., why not in the Philippines?"

The suppliers

As the phone line goes dead, Wade knows that the body broker need only dial a few more folks on a growing list of about 700 tissue banks to find someone who will part with a body — for a price.

Tissue banks are at the center of the controversy. Within hours after a death, workers from tissue banks remove parts of the eye that give sight, ligaments for knee surgeries, skin for burn patients and other parts for the living. They get most of their bodies from hospitals that ask grieving family members whether the person who has just died wanted to make the gift of life. Usually, the person has spelled out his or her wishes before death and has, perhaps, signed an organ donor card.

Less reputable, non-accredited tissue banks don't stop at removing the tissue needed for transplant.

"You remove the cornea, and the head is still salable. You remove the skin, and joints are still salable. This is the main source of body parts," says Todd Olson, a professor of anatomy at Albert Einstein College of Medicine in New York — a state that has taken steps to regulate the willed-body trade. "Unfortunately, a significant number of tissue bank organizations are not conscientiously dealing with the rest of the remains."

Olson calls it unlikely that those who drafted the laws banning the sale of organs and tissue for transplant ever anticipated that other body parts would become a salable commodity. "In the spirit in which they (the bans) were drafted, this generous donation was not meant to profit someone else," he says.

There are three kinds of body-part donations. The most attention is paid to organ donation for transplant, a highly regulated process overseen by the U.S. Department of Health and Human Services.

Second is tissue donation for transplant. There are fewer regulations, but the tissue banks still must meet strict rules about how material is handled, tested and prepared for transplant.

Third is the donation of a body for research. There is virtually no federal oversight of how cadavers and body parts are moved across the country for research and training.

The big money — and the profit — is in the details.

Handlers such as the one who called Wade at the University of Maryland can charge thousands of dollars for the storage, transportation and processing of each body part they deliver. The well-connected body broker with a knack for finding someone who wants all of a body's parts can make between $100,000 and $300,000 per body. Even if he can't get the body as a research donation and has to pay a disreputable tissue bank $5,000 for it, he still makes a handsome sum.

Bob Rigney, executive director of the American Association of Tissue Banks, which has accredited 83 tissue banks, says most accredited banks turn away body brokers. "Our banks get calls all the time looking for this, that or the other thing, body parts or some organ or tissue," he says. "My experience has been that most of the banks we accredit don't deal with tissue for research, period."

When a tissue bank turns a broker away, the search for a body may lead to a medical school, another major source of bodies. When medical schools have more bodies than they need to teach with, they can release extra specimens to other schools and other researchers.

The UCLA scandal, experts say, shows that more oversight is needed to protect the dead from body-parts trafficking. Demand is growing, supply is limited and the market is hot.

"UCLA tried to make fixes years ago" by hiring licensed contractors to handle remains from the willed-body program, says Wade, who also is co-chair of the anatomical services committee for the American Association of Clinical Anatomists.

"Those were Band-Aid fixes," he says. "If the whole thing is broken, you have to step back. You have to look back and see what is driving this machine. It's money."

UCLA agrees. Thomas Rosenthal, associate vice chancellor of UCLA's medical school, says "temptations" are strong for those who handle bodies. "It is clear from our experience that there is money to be made," he says.

Growing demand

The demand for body parts has created a growing field of companies that supply bodies on a larger scale.

Many surgeons go to two big centers if they need to practice on cadavers. The Medical Education and Research Institute in Memphis and the Orthopaedic Training Center in Rosemont, Ill., both obtain bodies and work with national physician groups to plan mass training sessions. Neither returned repeated calls seeking information for this story.

Another company is ScienceCare, based in Phoenix, which has turned to funeral homes as far as New York. The funeral homes can facilitate cadaver donations.

Although ScienceCare is an accredited tissue bank, Rigney says it does not recover tissue for transplantation, focusing only on parts for research. The company refused to comment, saying in an e-mail that it works with "sensitive end-of-life issues."

These operations are said to be meeting a large and legitimate need by supplying the cadavers needed for medical training seminars. Surgical advancements also have caused spikes in medical errors. When doctors try out a new skill on patients, the results can be damaging. So they increasingly are turning to cadaver labs to learn.

"As a surgeon, I am doing nothing that I was trained to do in my residency," says Nicholas DiNubile, an orthopedic consultant with the Philadelphia 76ers pro basketball team and the Pennsylvania Ballet, who has relied on cadaver training to learn many new techniques. In the 22 years since he finished his medical training, medicine has "evolved so much that the work I do is completely different than my training."

Although no nationwide count is available, thousands of surgeons work on donated bodies and parts each year.

Sometimes, these sessions are held in hotel rooms — a practice that experts say puts other guests at risk of disease. "They are grinding tissue, drilling through tissue, and there is particulate matter in the air," Wade says. "They are working on specimens on the ground floor near the lobby, and what happens if somebody on the 12th floor starts coughing? Are they exposing everybody in their hotel to a health risk? Certainly they are."

The solution

Those who want to see an end to profiteering from body parts say professional medical organizations can help clean up the business by requiring brokers to provide detailed accountings for every part.

"Most of the time, the broker won't tell you where the body came from," Wade says, but the doctors, who are key to courses, have ethical standards and a responsibility to public health. "The sales guys don't teach the courses. They have to put a doctor in there."

Olson says the medical organizations, such as the American Medical Association and the Accreditation Council for Continuing Medical Education, should insist on knowing where the body parts used for training came from. "They should know where it came from, how it got here, where it is going to be used, and how it is going to be disposed," he says, "as well as what costs were incurred in each of the transactions."

Similarly, big companies such as Johnson & Johnson and subsidiaries that use the parts to develop new surgical instruments could "take a more ethical stand in doing business" by establishing guidelines and oversight of the bodies, says Olson, who serves with Wade at the American Association of Clinical Anatomists. "They have a willing partner here at the AACA. Our door is open."

"We take the matter of using human tissue samples for medical research and education very seriously. We are sensitive to the need that all samples are appropriately and properly obtained, stored and shipped," says Johnson & Johnson's Marc Monseau. "Therefore, many of our companies work directly with accredited tissue banks, laboratories and medical schools that comply with federal, state and local laws and regulations."

Proposed FDA regulations may soon call for more record-keeping and more quality-assurance measures in tissue banks, but the agency has no plans to regulate brokers of body parts for research.

Olson says only the buyers can force a cleanup of the trade. "They have it in their power to say if we are going to do business with you, if you are going to provide these specimens, you have to provide us documentation and declare something about the cost associated with this contract," Olson says. "They could do that tomorrow."

"Most people with common sense and common spirit will say this has to stop," Olson says.